Community and Collaboration: How ABIM Revised Procedural Requirements for Initial Certification in Nephrology

Rudolph A. Rodriguez, MD, is the Director of the Hospital & Specialty Medicine Service Line at the VA Puget Sound Health Care System and a Professor and Vice Chair of the Department of Medicine at the University of Washington. He has served as Chair of the ABIM Nephrology Board since 2020.

In September 2023, the ABIM Nephrology Board finalized changes to the procedural requirements for initial certification in nephrology in a culmination of more than two years of policy review, interorganizational collaboration within the nephrology community, input from certified nephrologists and nephrology fellowship directors, and careful deliberation by and feedback from numerous other stakeholder groups. As a result, the new requirements better reflect current practice for nephrologists and national policies to expand care choices and access to home dialysis and transplantation for kidney disease patients.

The new requirements will apply to nephrology fellows entering training programs in July 2024, and nephrology fellowship program directors will begin attesting to fellows meeting the requirements upon graduation in 2026. We recognize there may be a ripple effect on some fellowship programs, such as the need to expand training opportunities in home hemodialysis therapies or adjustments to meet the Opportunity-to-Train standard.

What’s New

The Nephrology Board approved the following procedural changes:

Procedures to be Performed Competently

• Acute hemodialysis and chronic hemodialysis
• Continuous renal replacement therapy
• Peritoneal dialysis (excluding placement of temporary peritoneal catheters). Training is required to full competency as determined by the program. This training should include:
  • Evidence of fellow involvement in the interprofessional nature of peritoneal dialysis delivery.
  • Attendance in at least 8 peritoneal dialysis clinic sessions each with at least one patient and with involvement of the peritoneal dialysis nursing staff at the clinic visit.
  • Fellow participation in the key aspects of peritoneal dialysis initial patient training.

Opportunity to Train¹ Standard
(Fellows must have the opportunity to train in the following procedural experiences to develop competence based on their perceived future needs) 

• Placement of temporary vascular access for hemodialysis and related procedures 
• Percutaneous biopsy of both autologous and transplanted kidneys 
• Home hemodialysis

Review the complete list of requirements here.

Collaboration and Community Impact

ABIM is the vehicle through which the internal medicine profession sets standards for itself. When making changes of this kind, staff and governance work together to follow a carefully laid out process for identifying what is important to external stakeholders before making policy decisions that impact physicians.

Recognizing that in the last 30 years, the practice of nephrology has changed dramatically, the Nephrology Board first began discussing updates to the requirements in 2021 and forming a plan with ABIM to vet proposed changes and new possible procedure requirements with the entire community of nephrology stakeholders. A detailed overview of the process and results can be read in this paper published by the American Journal of Kidney Diseases. In brief, the timeline was as follows:

• November 2021: ABIM polled nephrology diplomates about procedures they use in practice.
• March 2022: ABIM polled nephrology diplomates again on current and possible new procedure requirements.
• March – June 2022: The American Association of Kidney Patients conducted independent outreach of kidney patients, advocates and providers on proposed procedural requirements.
• April 2022: The American Society of Nephrology formed a task force charged with considering how to best prepare fellows for future challenges and opportunities.
• November 2022: ABIM polled nephrology training program directors on current and emerging procedures.
• January 2023: The Nephrology Board drafted proposed changes to the requirements.
• March 2023: ABIM launched a public comment period during which nephrologists could anonymously provide feedback on the proposed changes.
• September 2023: The Nephrology Board met to discuss the breadth of feedback received and vote on changes.
• January 2024: The new procedural requirements were published on ABIM’s website.

The changes better reflect the current state of training in most fellowships and practice, and are intended to align with national policy, for example, the 2019 Executive Order on Advancing American Kidney Health, which established increased access to home dialysis as a national priority in response to patient and kidney community requests.

ABIM is committed to following this kind of collaborative and transparent approach to oversight of assessment in the disciplines of internal medicine when enacting policy changes that affect physicians. Every key group was involved in this policy journey of two years, including nephrology diplomates, fellowship directors, and professional and patient organizations. More importantly, this collaboration will be an ongoing process as ABIM continues to monitor the new requirements and future revisions related to possible new procedure requirements. Diplomates and other key stakeholders will always have a voice in the work that impacts how they train and practice.

Read about the policy journey toward updating the requirements in this paper published by the American Journal of Kidney Diseases in May.

Learn more about the work of the Nephrology Board in these blog posts.